Open Access Case Study

Study about Multisystem Autoimmune Disorder: Systemic Lupus Erythematosus, A Third World Prodigy

Saba Saleem Qazi, Syed Muhammad Ismail Shah, Naheed Maher, Santosh Kumar, Pareesa Memon, Ramil Dadabhoy

Journal of Pharmaceutical Research International, Page 14-21
DOI: 10.9734/jpri/2022/v34i18B35789

Childhood-onset Systemic Lupus Erythematosus (SLE) has an incidence of 0.3-0.9/100,000 children. It is very rare to find a case of childhood-onset SLE before 5 years of age. We describe a case of a 4-year-old female child, from a low-socioeconomic background who was diagnosed with SLE based on a typical rash, oral ulcer, positive laboratory parameters such as ANA, anti-ds DNA, anti-nucleosome, anti-histone antibodies, and positive lupus anticoagulants. There was an involvement of each system with considerable signs and symptoms including lupus nephritis, a cardiological complication such as Libman-Sack endocarditis, and neurological manifestations showing diffuse cerebral atrophy. The child was also positive for parameters linking to the presence of Macrophage Activation Syndrome MAS). The hypercoagulable state of SLE has been linked to more central nervous system involvement, cardiovascular dysfunction, renal complication, and hyponatremia as indicated in our case making it more riveting.

Open Access Original Research Article

Antimicrobial and Biochemical Properties of Linum usitatissimum the Flax Seeds and Syzygium aromaticum

Sumbal Babar, Iqra Rafi, Adeel Iqbal, Aisha Nawaz, Tahira Leghari, Muhammad Khawar Abbas, Muhammad Mohsin Zaman, Faheem Hadi, Tahir Maqbool, Nazar Hussain, Qurban Ali

Journal of Pharmaceutical Research International, Page 22-28
DOI: 10.9734/jpri/2022/v34i18B35792

Introduction: The current research was performed to evaluate antimicrobial, anti-fungal and biochemical properties of Linum usitatissimum (flax seeds) and Syzygium aromaticum (clove). Flaxseeds is one of dietary sources containing phenolics, named lignans. Syzygium aromaticum ordinarily called clove is generally considered second important flavor in world and is broadly developed in North Maluku Islands in Indonesia. Glycosides, saponins, flavonoids, steroids, tannins, alkaloids, terpenes, and other phytochemical constituents have been shown to have pharmacological actions in different activities. Syzygium aromaticum (clove) and Linum usitatissimum (flax) have unique pharmacological effects and have been utilized for food safety.
Materials and Methods: In this study, ethanolic, methanolic and aqueous extracts of Linum usitatissimum and Syzygium aromaticum were evaluated against the 3 bacterial strains and 2 contagious fungal strains viz. A. niger and F. solani.
Results: Among the bacterial strains i.e., E. coli, P. syringae and B. subtilis, antimicrobial action was noted by Syzygium aromaticum against E. coli, methanolic and aqueous extract of Linum usitatissimum and ethanolic extract of S. aromaticum showed antimicrobial action against the P. syringae and B. subtilis. Best antimicrobial action was observed by the ethanolic extract of the L. usitatissimum and methanolic and aqueous extract of S. aromaticum. Regarding parasitic strains of A. niger and F. solani, 3 extracts of L. usitatissimum showed satisfactory results against A. niger strain and 2 extracts (ethanolic and methanolic) of S. aromaticum against F. solani strain, whereas aqueous extracts of both the plants had no effect against F. solani strain. The phytochemical screening showed presence of terpenoids, tannins, flavonoids, saponins and cardiovascular glycosides in both plants.
Conclusion: Flaxseed and clove extracts were found potent antimicrobial agents.

Open Access Original Research Article

Qt-Prolongation Associated with Medication Combination in Hospitalized Patients at Johns Hopkins Aramco Healthcare (JHAH), KSA

Mohammed Alhabib, Rahmah Majed Alhumaid, Abdullah Mohammed G. Alenezi, Renad Huwaydi Alanazi

Journal of Pharmaceutical Research International, Page 29-36
DOI: 10.9734/jpri/2022/v34i18B35795

Background: Long QT syndrome (LQTS) is a myocardial repolarization dysfunction characterized by QT-interval prolongation on electrocardiogram (ECG). Patients with long QT syndrome have a corrected QT interval (QTc) prolongation greater than 460 milliseconds (0.46 seconds). The long QT syndrome has a direct association with an increased risk of a serious type of arrhythmias called ‘Torsades de Pointes (TdP)’, a polymorphic ventricular tachycardia. QT-interval prolongation and the consequent life-threatening Torsade de Pointes may develop in both outpatient and inpatient setting, however, the risk is thought to be higher among hospitalized patients. This is mainly because admitted patients usually receive multiple drugs and may have other risk factors, including electrolyte disturbances and hepatic or renal impairment. This study is an attempt to address the issue of QT-prolongation and its prevalence among hospitalized patients, and evaluate the safety of prescribing patterns of QT-prolonging drugs selected in the study. The aim is to determine which drugs physicians more commonly prescribe and whether or not they cause long QT-interval in patients. Our paper also aims to provide general recommendations for a safer practice. We aim to extend the current knowledge and highlight this overlooked adverse effect in the clinical practice.

Methods: This retrospective study was conducted based on electronic health records (EHRs). The Institutional Review Board (IRB) of Johns Hopkins Aramco Hospital approved the study. The data were extracted from EPIC healthcare system at Johns Hopkins Aramco Healthcare (JHAH) in Dhahran, Saudi Arabia on 122 hospitalized patients. The statistical software program GraphPad Prism 9.0.0 version was used to analyze and generate the figures.

Results: Nearly half of them (51.6%) were arrhythmic patients. The duration of therapy was also considered, and we found that the majority of patients were on a short-term therapy (76.2%). Two-drug regimen was the most commonly observed (46.6% of patients), whereas nearly 30% were prescribed three or more QT-prolonging drugs. In respect to drug classes, the serotonin antagonist drug (ondansetron) was the most commonly prescribed agent among our patient population (69.6%). The corrected QT-interval (ECG reading) varied among patients; however, all subjects experienced QT-prolongation with varying degrees. Fifty-five per cent of patients fell into the 440-469 ms category, 22.9% were borderline (470-499 millisecond) and 12.3% had a clinically significant long QT syndrome (≥500 millisecond).

Conclusion: A substantial number of patients presented with drug-induced QT prolongation with varying degrees. Scores of ≤500 ms does not mean nor eliminate the risk of developing fatal arrhythmias. Proper considerations are needed in order to optimize and minimize the use of drugs that are associated with long QT syndrome. This adverse effect usually goes undetected in real-world practice. ECG monitoring should be recommended in patients who are receiving two or more QT-prolonging drugs, elderly, and/or have other risk factors.

Open Access Original Research Article

Association of Human Papilloma Virus in Oral Squamous Cell Carcinoma

K. A. Fabi Samad, Jagadish Chandra, Joyce P. Sequeira

Journal of Pharmaceutical Research International, Page 37-43
DOI: 10.9734/jpri/2022/v34i18B35796

Introduction: Oral squamous cell carcinoma is the most common malignant epithelial neoplasm affecting the oral cavity.it is commonly seen in the lip, oral cavity, salivary glands. Worldwide, oral cancer accounts for 2%–4% of all cancer cases. Although tobacco and alcohol are the main etiologic factors in majority of these cancers, the etiological factor in 1/4th of the cases remains unidentified. There is a growing evidence that human papilloma virus (HPV) may act as a cocarcinogen along with tobacco which eventually results in oral cancers.

Hence, this study is focused on evaluating the expression of HPV in OSCC and to correlate the association of HPV in OSCC patients.

Aim: The aim of this study is to analyze the presence of human papilloma virus in oral squamous cell carcinoma using p16 tumor biomarker and to compare the presence of human papilloma virus in tobacoo related and non tobacoo related oral squamous cell carcinoma.

Methodology: A 100 histologically diagnosed OSCC patients were selected for the study and sections were made to evaluate the presence of HPV using P16 tumor marker.

Results: Out of the total 100 patients the presence of HPV was seen in only 3 patients. Tongue was the common site with a male predilection. Even though non smokers were more in the study, the presence of HPV was seen in patients with smoking habit. Thus correlating the relationship between presence of HPV and smoking habit.

Conclusion: There is no significant association between OSCC and HPV in our study. Our study also proves that there is an association between HPV and smoking habit. However considering our sample size, a larger sample size can be consider to prove the association between OSCC and HPV.

Open Access Original Research Article

Frequency of Aids Defining Opportunistic Infections in Hospitalized HIV Infected Patients

Saliha Bano, Gohar Ali, Nabiya Sandeelo, Abu Talib, Hari Lal, Mumtaz Ali Lakho, Syed Zulfiquar Ali Shah

Journal of Pharmaceutical Research International, Page 44-51
DOI: 10.9734/jpri/2022/v34i18B35798

Background: Human Immunodeficiency virus patients with AIDS defined opportunistic infections with Pneumocystis jiroveci, cryptoccocal, disseminated TB, cytomegalovirus, and cytomegalovirus associated retinitis, and cryptospordiasis.

Objective: To determine the frequency of AIDS defining opportunistic infections in hospitalized HIV infected patients.

Methodology: This cross sectional study was conducted from 21st October 2018 to 20th April 2019 at Department of Medicine, Civil Hospital, Karachi. Total 154 diagnosed patients of HIV were included. For diagnosis of various AIDS defining illness, clinical, radiological and bacteriological evidence of disseminated tuberculosis chronic cough, and weight loss diagnosed by AFB smear/ gene experts. Pneumocystis jiroveci was diagnosed by bronchoalveolar lavage and CD4 counts. Cryptosporidiosis with watery diarrhea and stool sample microscopy, cerebral toxoplasmosis with headache, hemiparesis, vomiting, diagnosed by serology and cytomegalovirus retinitis with blurred vision diplopia, vision impairment and Cryptococcal meningitis with fever >98.6oF. Headache, stiff neck, photophobia diagnosed by microscopy, culture, or antigen was done. Descriptive statistics were calculated and stratification was done. Post stratification chi square test was applied. P value ≤0.05 was taken as significant.

Results: There were 71.4% male and 28.6% female patient. The mean HIV duration was 15.25±5.09 months. The overall mean CD4 count was 174.17±12.85/cumm. 18.8% patient were found with disseminated tuberculosis, 31.2% with pneumocystis pneumonia, 12.3% with cerebral toxoplasmosis, 18.2% with cryptococcal meningitis, 3.9% with cryptospordiasis and 14.9% with cytomegalovirus retinitis.

Conclusion: Pneumocystis pneumonia was the most prevalent infection followed by disseminated tuberculosis, cryptococcal meningitis, cytomegalovirus retinitis, cerebral toxoplasmosis, and cryptospordiasis.

Open Access Review Article

Willingness-To-Pay for COVID-19 Vaccine in Low and Middle-Income Countries Compared to High-Income Countries: A Systematic Review

Rizka Prita Yuliani, Susi Ari Kristina, Dwi Endarti

Journal of Pharmaceutical Research International, Page 1-13
DOI: 10.9734/jpri/2022/v34i18B35788

Aims: By focusing largely on lower-income countries, this study adds to the evolving worldwide picture of willingness to pay for COVID19 vaccination. Willingness-To-Pay (WTP) values for the pandemic COVID-19 vaccine, which provide monetary indicators of community preferences for vaccines, could help policymakers in low- and middle-income countries determine priorities for health resource utilization.

Study Design: Systematic Review.

Methodology: A systematic review of the study on willingness to pay for COVID-19 vaccine in the Pubmed, Science Direct, and Scopus through January 2022 was performed to find relevant articles published between January 2020 and January 2022. Following PRISMA guidelines, the study yielded 19 English-language studies (12 studies in low- and middle-income countries, 2 in high-income countries, and 5 in upper-middle-income countries) that evaluated WTP for COVID-19 vaccines, either existing or hypothetical vaccines. All WTP values extracted were converted to 2021 United States Dollars (USD) for comparability

Results: This study showed that the willingness to pay in low-middle-income countries varied from USD 1.2 to USD 85.92. Studies conducted in the same country might have different WTP values. Average WTP in low-income countries have lower WTPs than high and upper-middle-income countries. In addition to being in line with differences in GDP, cases and deaths from COVID-19 in high-income countries are higher than in low-income countries.

Conclusion: From low-middle income countries evaluation, the high value of WTP is not consistently aligned with the high value of GDP per capita from each country. The finding demonstrates that the factors that affect the value of WTP are not only the GDP per capita of the country. The perception of risk, the WTP evaluation method used, and several other factors that need to be studied further also affect the amount of WTP.